Bel Alonso E, Grember A, Cheval C, Papillon R, Mairot L, Deroux A, Bouillet L, Bellier A, Dumanoir P
Emergency Department and Mobile Intensive Care Unit, University Hospital of Grenoble Alpes, 38700 La Tronche, France.
Emergency Department and Mobile Intensive Care Unit, University Hospital of Besançon, 25030 Besançon, France.
Life (Basel). 2025 May 7;15(5):752. doi: 10.3390/life15050752.
Lung ultrasound (LUS) has emerged as a simple, rapid, and non-invasive method for the dynamic assessment of pulmonary congestion, a major prognostic factor and a therapeutic target in acute heart failure (AHF). In a single-center prospective observational study, 42 patients hospitalized for AHF in the post-emergency polyvalent medicine department of CHU Grenoble were successively included between May 2021 and July 2022. Patients undergoing hemodialysis, those with pneumonectomy or lung fibrosis, or those placed under guardianship or deprived of freedom were excluded. Clinical examination, LUS, and electrolyte panel results were collected daily. Vital status was assessed 30 days after the last LUS. The primary endpoint was the evolution of the number of B-lines in relation to the dose of diuretic administered. Secondary endpoints included the evolution of B-lines according to clinical signs of congestion and plasma creatinine levels, the agreement between LUS and clinical findings at discharge, and the prognostic value of LUS at discharge for 30-day re-admission for AHF and all-cause mortality. A total of 188 LUS were performed. The patients were elderly (85.8 years [SD 8.1]) and comorbid. The median number of B-lines decreased from 17 at admission to 7 mid-hospitalization, then stabilized. The median daily intravenous diuretic dose declined from 40 mg to 20 mg. Patients with chronic kidney disease (CKD) had more B-lines at admission (24.2 (SD 11.6) vs. 8.2 (SD 8.8)). However, B-line evolution was independent of creatinine levels. Higher B-lines at discharge were significantly associated with 30-day mortality (15.2 vs. 3.9, < 0.001). In the absence of a gold standard for the assessment of pulmonary congestion, LUS appears to be an additional tool for optimizing the management of AHF.
肺部超声（LUS）已成为一种简单、快速且无创的方法，用于动态评估肺充血，肺充血是急性心力衰竭（AHF）的主要预后因素和治疗靶点。在一项单中心前瞻性观察研究中，2021年5月至2022年7月期间，格勒诺布尔大学医院急诊多科病房收治的42例AHF患者相继入组。排除接受血液透析的患者、接受肺切除术或患有肺纤维化的患者，以及处于监护或被剥夺自由的患者。每天收集临床检查、LUS和电解质检测结果。在最后一次LUS检查30天后评估生命状态。主要终点是B线数量相对于利尿剂给药剂量的变化。次要终点包括根据充血临床体征和血浆肌酐水平的B线变化、出院时LUS与临床检查结果的一致性，以及出院时LUS对AHF 30天再入院和全因死亡率的预后价值。共进行了188次LUS检查。患者年龄较大（85.8岁[标准差8.1]）且合并多种疾病。B线中位数从入院时的17条降至住院中期的7条，然后稳定下来。每日静脉注射利尿剂的中位数剂量从40毫克降至20毫克。慢性肾脏病（CKD）患者入院时的B线更多（24.2[标准差11.6]对8.2[标准差8.8]）。然而，B线的变化与肌酐水平无关。出院时较高的B线与30天死亡率显著相关（15.2对3.9，<0.001）。在缺乏评估肺充血的金标准的情况下，LUS似乎是优化AHF管理的一项辅助工具。
